While the solution for hospital supply shortages may be to ramp up production, a finite number of nurses and specialists stretch short staffs even thinner.

Laurie Kuypers, a registered nurse, reaches into a car to take a nasopharyngeal swab from a patient at a drive-through COVID-19 coronavirus testing station for University of Washington Medicine patients in Seattle, on March 17, 2020.(Elaine Thompson / AP)

Well before anyone knew of COVID-19, workforce experts warned that Texas faced an impending nursing shortage.

The Texas Center for Nursing Workforce Studies in 2016 projected that Texas would have an unmet demand of 60,000 registered nurses by 2030. In 2017, the National Center for Health Workforce Analysis projected the state would have the second largest shortage of registered nurses in the country by that same year, behind only California.

Those familiar with nursing and specialist staffing agree that hospitals were already feeling the effects of personnel shortages, characterized by longer hours, heavier caseloads and exhaustion of staff. These experts say that unlike supplies such as beds, hospitals can’t rely on a second wave of health care providers to become available, especially as some staff members are expected to become sick with COVID-19 themselves.

“We’ll have plenty of beds; we’ll have plenty of ventilators,” said Britt Berrett, former president of Texas Health Presbyterian Hospital Dallas and former CEO of Medical City in Dallas. “The supplies will not be the shortcoming, it will be personnel.”

‘If you can’t breathe, nothing else matters’

Berrett, currently director for the Center of Healthcare Leadership and Management Program at UT Dallas, praised Abbott’s waiver but said he is especially concerned about the lack of respiratory therapists and hoped such staff could be granted similar waivers. The most recent data from the Bureau of Labor Statistics in 2017 shows that there are about 2,000 respiratory therapists in the Dallas-Plano-Irving metro area, or about 40 for every 100,000 residents. Comparatively, there are 41,000 nurses, over 800 for the same number of residents.

These respiratory specialists perform diagnostics and therapy on patients with breathing issues and operate breathing equipment such as ventilators, which have become increasingly in demand for COVID-19 patients.

The extra ventilators are “meaningless” if there are not enough respiratory therapists to manage the patients, Berrett said.

Idichandi Idicula, respiratory care program coordinator at El Centro College in Dallas, said it is hard for him to attract applicants to his program because most students interested in the medical field don’t have respiratory therapy on their radar, despite the specialists playing a vital role in rehabilitating patients with breathing problems. Last year, only 15 students graduated from his program.

“If you can’t breathe, nothing else matters,” Idicula said.

There is a push from some organizations to move a respiratory therapist degree from an associate’s degree to a bachelor’s degree, Idicula said, but he fears a longer program will create a barrier for entry for future applicants.

Idicula believes if students were allowed to get some form of limited license before they graduate, allowing them to be hired by employers earlier, they could help alleviate pressure on hospital staff if there is a shortage, even if they weren’t managing the neediest patients.

Future and past nurses alike look to help

Cindy Zolnierek, CEO of the Texas Nurses Association, said she was pleased to see Abbott’s nursing waivers, one of which allows retired nurses to get back into the workforce.

“Retired nurses want to help,” Zolnierek said. “It’s a calling.”

Zolnierek hopes that Abbott’s office will also waive restrictions on advanced practice registered nurses, such as nurse practitioners, that would relieve them from physician supervision. Zolnierek said it’s a requirement that creates unnecessary red tape during a crisis like COVID-19.

Another waiver Abbott put into place allows students in the final year of their nursing programs to satisfy more of their required clinical hours virtually or in a lab rather than in person. Since hospitals began admitting COVID-19 patients, nursing students have been prevented from completing their required clinical hours in person.

Rosalie Mainous, dean of the College of Nursing at Texas Woman’s University, commended the decision, saying it would allow students to continue their training and enter the workforce on schedule this summer as registered nurses.

However, Mainous said that even before their licensure, current students are an untapped resource. She believes senior nursing students could relieve nurses who are on the front lines by taking care of less sick patients in hospitals, helping with screenings or at drive-by testing centers.

Currently, nursing students are not considered essential personnel under Dallas County’s shelter in place order, though Dallas County Judge Clay Jenkins could lift that restriction. Once that barrier is removed, Mainous believes it would take a conversation among deans of nursing colleges and chief nursing officers to figure out how nursing students can best alleviate a staffing shortage if — or when — hospitals become overburdened.